Image in medicine
Skin ulcers associated with dermatomyositis MDA5
Úlceras cutáneas asociadas a dermatomiositis MDA5
Laura Martínez-Díaz
, Laura Jiménez-de la Cruz, Marta Moret-Rueda, Ismael Calero-Paniagua
Corresponding author
Servicio de Medicina Interna del Hospital Virgen de La Luz, Cuenca, Spain
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She also reported weight loss and diffuse alopecia during the targeted history-taking. Physical examination revealed extensive necrotic ulcers on the fingers and the back of both hands (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>A and B; corresponding to the onset of the clinical manifestations), in addition to lesions compatible with Gottron's papules, heliotrope erythema and the shawl sign.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">Laboratory tests revealed leukocytosis, elevated C-reactive protein, and 1/1280 antinuclear antibodies with a homogeneous pattern, with the rest of the work-up being normal. Despite not reporting muscle weakness and having normal creatine kinase levels, an electromyogram was requested, which showed moderate myopathic involvement, predominantly involving proximal muscle groups in the upper limbs. In view of the suspected inflammatory myopathy, specific antibodies were determined and the anti-MDA5 antibody was positive. Positron emission tomography and respiratory function tests were requested, which were normal. Treatment was started with calcium antagonists, alprostadil, antiplatelet agents and bemiparin, combined with methylprednisolone pulses and antibiotic therapy, with clear clinical improvement. On discharge, bosentan and methotrexate were added to the treatment, with excellent clinical progress over the following months (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>C and D, corresponding to resolution after treatment).</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Patient consent</span><p id="par0015" class="elsevierStylePara elsevierViewall">The authors have obtained the informed consent of the patients and/or subjects referred to in this article.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0020" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Funding</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that they did not receive funding for this article.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Clinical case" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Patient consent" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Conflict of interest" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Funding" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 975 "Ancho" => 1600 "Tamanyo" => 263758 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Figure " "rol" => "short" ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23870206/0000016000000003/v1_202302051543/S2387020623000074/v1_202302051543/en/main.assets" "Apartado" => array:4 [ "identificador" => "51820" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Images in medicine" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23870206/0000016000000003/v1_202302051543/S2387020623000074/v1_202302051543/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020623000074?idApp=UINPBA00004N" ]
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